International Journal of Colorectal Disease

, Volume 33, Issue 11, pp 1607–1616 | Cite as

Management of iatrogenic perforation during colonoscopy in ulcerative colitis patients: a survey of gastroenterologists and colorectal surgeons

  • David DiCaprioEmail author
  • Steven Lee-Kong
  • Guillaume Stoffels
  • Bo Shen
  • Ahmed Al-Mazrou
  • RP Kiran
  • Burton Korelitz
  • Arun Swaminath
Original Article



Patients with ulcerative colitis, a high-risk group for the development of colon cancer, undergo colonoscopy more frequently than the general population. This increase in endoscopic evaluation also exposes these patients to an increased risk of complications, including iatrogenic perforation. Our survey study aims to determine factors that affect the management choices for iatrogenic perforations for ulcerative colitis patients in remission and identify areas of consensus among general gastroenterologists, inflammatory bowel disease specialists, and colorectal surgeons.


An anonymous, cross-sectional survey was performed using an online platform. A matrix questionnaire posed five clinical scenarios with six management options for an iatrogenic perforation in ulcerative colitis patients with varying disease distribution, disease activity, and maintenance regimens.


One hundred thirty-eight general gastroenterologists, 35 inflammatory bowel disease specialists, and 174 colorectal surgeons responded to the survey; 47, 41, and 23%, respectively, answered they did not feel comfortable managing perforations in ulcerative colitis patients in remission. We found the greatest concordance among gastroenterologists and colorectal surgeons in cases of perforation in ulcerative colitis with a history of dysplasia; the majority of respondents chose staged total proctocolectomy with ileal pouch anal anastomosis. We found discordance in decision making for ulcerative colitis in remission without dysplasia, with perforation occurring in colitis involved and uninvolved areas.


Our survey revealed that a significant fraction of gastroenterologists and colorectal surgeons are uncomfortable managing iatrogenic colonic perforations in ulcerative colitis patients. We have identified knowledge and practice gaps in defining the optimal management of iatrogenic perforations in ulcerative colitis patients.


Ulcerative colitis Inflammatory bowel disease Iatrogenic perforation Colorectal surgery 

Supplementary material

384_2018_3112_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb)


  1. 1.
    Langholz E (2010) Current trends in inflammatory bowel disease: the natural history. Ther Adv Gastroenterol 3:77–86. CrossRefGoogle Scholar
  2. 2.
    Eaden J, Mayberry J (2002) Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut 51(Suppl 5):V10–V12CrossRefGoogle Scholar
  3. 3.
    Itzkowitz S, Present D (2005) Consensus conference: colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis 11(3):314–321CrossRefGoogle Scholar
  4. 4.
    Bielawska B, Day A, Lieberman D, Hookey L (2014) Risk factors for early colonoscopic perforation include non- gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol 12(1):85–92CrossRefGoogle Scholar
  5. 5.
    Makkar R, Shen B (2013) Colonoscopic perforation in inflammatory bowel disease. Gastroenterol Hepatol 9(9):573–583Google Scholar
  6. 6.
    Navaneethan U, Parasa S, Venkatesh P, Trikudanathan G, Shen B (2011) Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized inflammatory bowel disease patients. J Crohns Colitis 5(3):189–195CrossRefGoogle Scholar
  7. 7.
    Luning T, Keemers-Gels M, Barendregt W, Tan A, Rosman C (2007) Manage: colonoscopic perforations: a review of 30,366 patients. Surg Endosc 21:994–997CrossRefGoogle Scholar
  8. 8.
    Strong S (2010) Management of acute colitis and toxic megacolon. Clin Colon Rectal Surg 23(4):274–284. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Howard R, Steele S, Varma M, Dykes S, Cima R, Buie W, Rafferty J (2014) Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum, 57(1):5-21Google Scholar
  10. 10.
    Cohen B et al (2016) State of adult trainee inflammatory bowel disease education in the US: a national survey. Inflamm Bowel Dis 22(7):1609–1615CrossRefGoogle Scholar
  11. 11.
    Wullstein C, Köppen MO, Gross E (1999) Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc 13:484–487CrossRefGoogle Scholar
  12. 12.
    Velez M et al (1997) Laparoscopic repair of a colonoscopic perforation. Surg Endosc 11:387–389CrossRefGoogle Scholar
  13. 13.
    Hansen A, Tessier D, Anderson M, Schlinkert R (2007) Laparoscopic repair of colonoscopic perforations: indications and guidelines. J Gastrointest Surg 11:655–659CrossRefGoogle Scholar
  14. 14.
    Stewart D, Chao A, Kodner I, Birnbaum E, Fleshman J, Dietz D (2009) Subtotal colectomy for toxic and fulminant colitis in the era of immunosuppressive therapy. Color Dis 11:184–190CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of GastroenterologyLenox Hill Hospital Northwell HealthNew YorkUSA
  2. 2.Division of Colorectal SurgeryNew York Presbyterian/ColumbiaNew YorkUSA
  3. 3.Biostatistics UnitFeinstein Institute of ResearchNew YorkUSA
  4. 4.Department of Gastroenterology and HepatologyCleveland ClinicClevelandUSA

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